Provider Demographics
NPI:1477093672
Name:KENYON-DIAZ, RAECHELE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:RAECHELE
Middle Name:
Last Name:KENYON-DIAZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15200 LA PALOMA WAY
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-9525
Mailing Address - Country:US
Mailing Address - Phone:530-440-2135
Mailing Address - Fax:
Practice Address - Street 1:15200 LA PALOMA WAY
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-9525
Practice Address - Country:US
Practice Address - Phone:530-440-2135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-07
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140052101YM0800X
CAVN256371164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No164X00000XNursing Service ProvidersLicensed Vocational Nurse